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Transcript
Onychomycosis DIAGNOSIS: “Onychomycosis” refers to fungal infection of the nail(s). Nails that are thickened, brittle, discolored, separating from the nail bed, and/or have subungual debris Adjacent skin involvement suspicious for fungal infection (erythematous, scaly, pruritic) Recurrence is common and treatment does not always guarantee a permanent cure. REFERRING PROVIDER: Try topical therapy with ciclopirox nail lacquer solution 8%. Apply to affected area nightly until nail clears Residue may be removed from nail once weekly with alcohol (not required) If lunula/matrix involved and fungal stain and/or culture are positive for dermatophyte, systemic therapy will be required to clear infection. Laboratory confirmation of fungal infection is frequently required by insurance to cover cost of medication and any recommended laboratory testing during treatment. Terbinafine (Lamisil) (comes as 250mg tab) o If no contraindications (e.g., history of significant liver disease or potential drug interaction) AND o If baseline CBC and LFT’s WNL: <20kg=62.5 mg/day 20-40kg+125 mg/day >40kg=250 mg/day Repeat CBC and LFT’s after 4 weeks on therapy prior to continuing course if treating for more than 6 weeks Fingernails o 6-week course Toenails o 12-week course Confirm presence of fungal infection o Send adequate clipping of involved nail for fungal stain (PAS) and/or fungal culture o Specimens for stain to go to pathology o Specimen for culture to go to microbiology WHEN TO REFER: Uncertain diagnosis Negative culture Unfamiliar with use of oral antifungal medications Concern for other cause of nail dystrophy